Alternating Tylenol and Motrin/Advil

On another thread someone had questioned the reasoning behind alternating Tylenol and Motrin/Advil and I wanted to help out with the "why".

Tylenol can be given every 4 hours, but typically the effects wear off sooner than that, such as after 2.5-3 hours. Motrin/Advil can be given every 6 hours, but again will usually wear off sooner than that. So, what are you going to do if your child has a fever/pain and the medicine wears off before you can give the next dose?

Alternating the two medicines is a huge help and can help keep things under control. Because they are different types of medicine (Tylenol is an acetominaphin, Motrin/Advil are ibuprofin) you CAN overlap them.

I always start with Motrin/Advil, because IMO it's a better pain reliever. So if I give Motrin/Advil at 9am, then I give Tylenol at 12noon, Motrin/Advil at 3pm, Tylenol at 6pm... Every 3 hours you are giving one, than the other. It keeps a constant level of pain relief going to your child, without technically giving them too much or overdosing. You could also do every 4 hours (instead of 3) if the pain/fever doesn't seem to be as bad, or if it doesn't seem to wear off as quickly. By alternating, you are technically still giving the Motrin/Advil every 6/8 hours, and same with the Tylenol.

I can't even tell you how many times this has been a life saver, especially when a fever is involved. With fevers, I would take the temperature just before giving the dose of medicine every time, to keep track of it and monitor progress. After a 24 hour period, I'd skip a dose (so no alternating) and take a temp at that 3 hour point, and then again at the 6 hour point to see if it was done. Example, gave medicine for 24 hours. The next day, 1st dose of the day (9am) was Motrin. Instead of giving Tylenol at noon, give nothing but take temp. Then take again at 3. If fever is still there (high temp) AND child is uncomfortable, give Motrin again and continue alternating process. Check again next morning. If temp is down and child seems to be acting more "normal" I don't give anything and reassess 3 hours later.

Now, I'm no medical expert or anything, but from experience, talking to pedi's, having several family members in the medical field, research, etc... this is the "theory" behind alternating and overlapping the two types of medicine.

Comments (3)

When you look up "Pediatric Fever" on EMedicine (a physician-geared website), this is what they say about 'antipyretics' (aka fever lowering drugs)

http://emedicine.medscape.com/article/801598-treatment

"Antipyretics

These agents provide patient comfort during the ED (emergency department) visit and are used liberally in febrile children. A child whose temperature has been reduced is more comfortable and more likely to have an optimal examination.

Acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) have both been used for fever control.16These drugs are sometimes alternated to achieve an overlapping period of fever control.51,52,53

Some studies have shown that acetaminophen works faster by initially lowering elevations in temperature.49Some studies have shown that ibuprofen takes longer to initially result in fever reduction but that its effect may last longer than that of acetaminophen.15

Hay et al studied whether administering a combination of acetaminophen and ibuprofen for fever in children was superior to administration of acetaminophen alone or ibuprofen alone.54Dosage was calculated as acetaminophen 15 mg/kg/dose and ibuprofen 10 mg/kg/dose. Children aged 6 months to 6 years whose fever could be managed at home (37.5-41ºC) were included. Use of acetaminophen and ibuprofen improved time without fever during the first 4 hours and was superior to acetaminophen alone, but not ibuprofen alone. The combination also decreased fever 23 minutes faster than acetaminophen alone, but no faster than ibuprofen alone. Time without fever during the first 24 hours was improved with the combination compared with either acetaminophen or ibuprofen."

I guess there are different schools of thought on this topic. When my LO at 10.5 months had a fever of 105, I immediately took him to the pediatric urgent care. I asked about alternating meds and was told it a) wasn't necessary, b) could do more harm than good.

I also think it's worth noting what is a high fever and when it's necessary to give meds to bring it down. From the Dr. Sears site:

Normal temperature – 97 to 99 degrees (36 to 37.2 Celcius).

Low-grade fever – 99 to 100.9 degrees (37.3 to 38.3 Celcius).

Common fever – 101 to 103.5 degrees (38.4 to 39.7 Celcius).

High fever – any fever over 103.6 degrees (39.8 Celcius

And here's what he says about alternating medications (italics are mine):

Using both medications – it is best to only use one of these two medications. However, if one by itself isn't enough or wears off too soon, then it is safe to give the other medication on top of the first without waiting. Another option is to alternate between them every 3 hours. Give acetaminophen at 8:00, ibuprofen at 11:00, acetaminophen at 2:00 and so on.

Not all fevers should be brought down with medication. Fevers are the bodies natural defense against disease and bringing it down and keeping it down could potentially prolong the illness it's trying to combat.

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